Provider Demographics
NPI:1376150383
Name:SHINING STAR ADULT CARE
Entity Type:Organization
Organization Name:SHINING STAR ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-370-0666
Mailing Address - Street 1:720 RUDY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5614
Mailing Address - Country:US
Mailing Address - Phone:240-370-0666
Mailing Address - Fax:
Practice Address - Street 1:720 RUDY DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5614
Practice Address - Country:US
Practice Address - Phone:240-370-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health